眼窩蜂窩織炎が疑われた眼球癆に発症した低分化癌の1例

Poorly differentiated carcinoma in a phthisic eye manifesting as orbital cellulitis

要約　目的：緑内障で眼球癆になった眼球に低分化癌が生じた症例の報告。症例：78歳男性が右上眼瞼の腫脹で紹介受診した。10年前に両眼の偽落屑緑内障と診断された。右眼に複数回の手術と毛様体光凝固を受け，眼球癆となって失明した。1か月前から右上眼瞼の腫脹があり，眼窩蜂窩識炎が疑われた。左眼は末期緑内障として経過観察中であった。所見：矯正視力は右測定不能，左0.02で，触診で右上眼瞼が固く触れた。CTで38×21mmの腫瘤が右眼瞼から眼窩にあった。経皮的に生検を行い，低分化癌と診断された。癌の発生母地は不明であったが，全身検索の結果，眼部原発と推定された。放射線照射で右眼の腫瘤は縮小した。4か月後に頸部リンパ節転移が生じ，放射線治療を行った。以後6か月後の現在まで，再発または転移はない。結論：失明眼であっても悪性腫瘍が生じる可能性があることを本症例は示している。

Abstract.　Purpose：To report a case of poorly differentiated carcinoma in a phthisic eye manifesting as orbital cellulitis. Case：A 78-year-old male was referred to us with swelling of right upper eyelid. He had been diagnosed with pseudoexfoliation glaucoma in both eyes 10 years before. The right eye had become phthisic after multiple surgeries including cyclophotocoagulation. The right eyelid became swollen one month before and was diagnosed with orbital cellulitis. Findings：Corrected visual acuity was no light perception right and 0.02 left. A hard tumor mass was detected in the right eye by palpation. Computed tomography showed a tumor measuring 38 mm by 21 mm in the right orbit. Biopsy led to the diagnosis of poorly differentiated carcinoma. It was assumed to have originated in the right eye after systemic examinations. Radiation induced reduction of orbital tumor. Metastasis developed in the cervical lymph nodes 4 months later. It was treated by radiation. There has been no recurrence or metastasis for 6 months until present. Conclusion：This case illustrates that malignancy may develop in a phthisic eye.